Extending the course of intravenous antibiotics in adult patients with cystic fibrosis with acute pulmonary exacerbations

Sequeiros, I.; Jarad, N.A.

doi:10.1177/1479972312445903

Cited by 14 publications

(16 citation statements)

References 26 publications

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“…Treating to improve patient signs and symptoms is a hallmark component of PEx management; however, it may not be indicative of downstream clinical outcomes. A CF symptom score during PEx30 has been associated with extending intravenous antibiotic duration17 and time to next PEx,31 but not when adjusting for other factors—similar to the findings of this study. The antibiotic course may be extended because of seeming lack of symptom improvement, but it is unclear if there are advantages to longer treatment that outweigh cost, time and potential toxicities.…”

Section: Discussionsupporting

confidence: 84%

“…For example, duration was a treatment factor in this analysis; however, antibiotic regimens often changed and extended mid-course presumably for reasons of clinical non-response, therefore treatment was confounded with outcomes and has been treated as such in other studies 15 17. Additions or changes to the treatment may have been related to microbial susceptibility testing or convenience/preference.…”

Section: Discussionmentioning

confidence: 99%

“…While studies have examined different short-term14–16 and long-term4 17 18 outcomes of PEx, and factors associated with them, there is no consensus on the most relevant or useful measure of PEx management success or failure.…”

Section: Introductionmentioning

confidence: 99%

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Short-term and long-term response to pulmonary exacerbation treatment in cystic fibrosis

Heltshe¹,

Goss

Thompson

et al. 2015

Thorax

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Background Treatment of pulmonary exacerbations (PEx) in cystic fibrosis (CF) varies widely with no consensus on management practices or best indicators of therapeutic success. To design trials evaluating PEx treatment factors, we characterize the heterogeneity of PEx care in adults and pediatrics, and correlate it with measures of clinical response including short and long term lung function changes, change in symptom severity score, and time to next intravenous (IV) antibiotic therapy. Methods Data were used from a prospective observational study of CF patients ≥10 years of age enrolled at six sites between 2007 and 2010. All were started on IV antibiotics for a clinically diagnosed PEx. ANOVA, logistic and Cox regression were used to examine the association of treatment factors with short and long term clinical response. Results Of 123 CF patients (60% female, aged 23.1±10.2 years), 33% experienced <10% relative improvement in FEV1 during treatment which was associated with failing to recover baseline lung function three months after treatment (OR=7.8, 95% CI=(1.9, 31.6), p=0.004) and a longer time to next IV antibiotic (HR=0.48, 95% CI=(0.27, 0.85), p=0.011). Symptom improvement was observed but was not associated with subsequent lung function or time to next antibiotic therapy which had a median recurrence time of 143 days. Conclusions Immediate symptomatic or respiratory response to PEx treatment did not have a clear relationship with subsequent outcomes such as lung function or IV antibiotic-free interval. These results can inform future research of treatment regimens for PEx in terms of interventions and outcome measures.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

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Short-term and long-term response to pulmonary exacerbation treatment in cystic fibrosis

Heltshe¹,

Goss

Thompson

et al. 2015

Thorax

View full text Add to dashboard Cite

show abstract

“…And, although symptoms and clinical picture (lung function and Matouk Disease score) have returned to baseline at the end of treatment, patients may still be experiencing some level of unresolved inflammation indicating the PE has not been cleared completely. There has been evidence that extending the course of antibiotics may only offer a small improvement in symptoms but not lung function or inflammation[46]. In these cases, perhaps a change in antibiotics and/or the use of anti-inflammatory agents to aid in the resolution of inflammation would benefit the patient and prevent early re-exacerbation.…”

Section: Discussionmentioning

confidence: 99%

Candidate Markers Associated with the Probability of Future Pulmonary Exacerbations in Cystic Fibrosis Patients

et al. 2014

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IntroductionPulmonary exacerbations (PEs) cause significant morbidity and can severely impact disease progression in cystic fibrosis (CF) lung disease, especially in patients who suffer from recurrent PEs. The assessments able to predict a future PE or a recurrent PE are limited. We hypothesized that combining clinical, molecular and patient reported data could identify patients who are at risk of PE.MethodsWe prospectively followed a cohort of 53 adult CF patients for 24 months. Baseline values for spirometry, clinical status using the Matouk Disease Score, quality of life (QOL), inflammatory markers (C-reactive protein (CRP), interleukins (IL)-1β, -6, -8, -10, macrophage inflammatory protein (MIP)-1β, tumor necrosis factor (TNF) and vascular endothelial growth factor (VEGF)), polyunsaturated fatty acids and lipid peroxidation in blood plasma were collected for all patients during periods of stable disease, and patients were monitored for PE requiring PO/IV antibiotic treatment. Additionally, we closely followed 13 patients during PEs collecting longitudinal data on changes in markers from baseline values. We assessed whether any markers were predictors of future PE at baseline and after antibiotic treatment.ResultsOut of 53 patients, 37 experienced PEs during our study period. At baseline, we found that low lung function, clinical scoring and QOL values were associated with increased risk of PE events. PEs were associated with increased inflammatory markers at Day 1, and these biomarkers improved with treatment. The imbalance in arachidonic acid and docosahexaenoic acid levels improved with treatment which coincided with reductions in lipid peroxidation. High levels of inflammatory markers CRP and IL-8 were associated with an early re-exacerbation.ConclusionOur results demonstrate that worse clinical and QOL assessments during stable disease are potential markers associated with a higher risk of future PEs, while higher levels of inflammatory markers at the end of antibiotic treatment may be associated with early re-exacerbation.

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“…antibiotic exposure to treat pulmonary exacerbations over a 1‐year period (not all i.v. courses are of the same duration) …”

Section: Methodsmentioning

confidence: 99%

Rescue therapy within the UK Cystic Fibrosis Registry: An exploration of predictors of intravenous antibiotic use amongst adults with CF

et al. 2017

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Background and objectiveIntravenous (i.v.) antibiotics are needed for rescue when preventative therapy fails to achieve stability among adults with cystic fibrosis (CF). Understanding the distribution of i.v. days can provide insight into the care that adults with CF need. We aim to determine the baseline characteristics that are associated with higher i.v. use, in particular to test the hypothesis that prior‐year i.v. use is associated with future‐year i.v. use.MethodsThis is a cross‐sectional analysis of the 2013–2014 UK CF registry data. Stepwise logistic regression was performed using current‐year i.v. days as the dependent variable, and demographic variables including prior‐year i.v. days as the covariates. Based on these results, study sample was divided into clinically meaningful subgroups using analysis similar to tree‐based method.ResultsData were available for 4269 adults in 2013 and 4644 adults in 2014. Prior‐year i.v. use was the strongest predictor for current‐year i.v. use followed by forced expiratory volume in 1 s (FEV1). Adults with high prior‐year i.v. use (>14 days) continued to require high levels of i.v., regardless of FEV1. Those with high prior‐year i.v. use and FEV1 ≥70% had higher current‐year i.v. days compared to adults with low prior‐year i.v. use and FEV1 <40% (28 days, interquartile range (IQR): 11–41 days vs 14 days, IQR: 0–28 days; Mann–Whitney P‐value <0.001 in 2013).Conclusion CF people with prior high levels of rescue often continue to need high levels of rescue even if they have good FEV1. The reasons for this require further investigations.

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Extending the course of intravenous antibiotics in adult patients with cystic fibrosis with acute pulmonary exacerbations

Abstract: Most severe pulmonary exacerbations (PExs)

Cited by 14 publications

References 26 publications

Short-term and long-term response to pulmonary exacerbation treatment in cystic fibrosis

Short-term and long-term response to pulmonary exacerbation treatment in cystic fibrosis

Candidate Markers Associated with the Probability of Future Pulmonary Exacerbations in Cystic Fibrosis Patients

Rescue therapy within the UK Cystic Fibrosis Registry: An exploration of predictors of intravenous antibiotic use amongst adults with CF

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